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<meta name="description" content="王海鹏老师的贴面班要求先读这本书，时间有限就读中文版了，据豆瓣上网友评论翻译的并不好。序言本书的中心内容是仿生修复的原则，是牙齿重建决策和成功的指导手册。作者的目的是通过对硬组织的粘接，恢复已预备过的牙体组织的全部功能，使功能性应力传导到整个牙齿，并使牙冠达到最终的美观效果。前言技术的进步并不总是使技术简化和治疗费用下降。要改善患者的利益，需要对知识和技术的更新采取谨慎而明智的态度。本书的核心内容">
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        <p>王海鹏老师的贴面班要求先读这本书，时间有限就读中文版了，据豆瓣上网友评论翻译的并不好。<br>序言<br>本书的中心内容是仿生修复的原则，是牙齿重建决策和成功的指导手册。作者的目的是通过对硬组织的粘接，恢复已预备过的牙体组织的全部功能，使功能性应力传导到整个牙齿，并使牙冠达到最终的美观效果。<br>前言<br>技术的进步并不总是使技术简化和治疗费用下降。要改善患者的利益，需要对知识和技术的更新采取谨慎而明智的态度。本书的核心内容是以粘结性瓷修复体（BPRs，瓷贴面）为代表的仿生原理的应用。<br>第1章 对完整牙齿的理解和仿生原则<br>对牙科修复医生来说，参照物毫无疑问是完整健康的天然牙齿。采用任何牙科修复学的概念进行治疗之前，都要对天然牙的完美设计有充分的研究和理解。<br>一、生物性、机械性、功能性、美观性<br>究竟是应该追求强度、硬度的提升，还是应该寻找另一种治疗模式，用来复制完整牙齿的生物力学性能。修复体更强、更硬并不总是好事。<br>二、理想的柔韧性和灵活性<br>在天然牙上强有力的自然保护的概念称之为柔韧性或弹性。这种可以储存能量而不遭受永久破坏的能力是前牙所固有的，并可以作为参考。在这种能力方面，牙本质是关键因素。过度的弹性也可能会使牙齿结构在同样的冲击下过于松软，缺乏刚性釉质外壳的单独牙本质核将缺乏足够的功能性。<br>具有理想的牙釉质与牙本质结合的天然牙表现出最佳的硬度、强度、弹性方面的平衡。修复的过程以及牙齿结构完整性的改变会破坏这种内在平衡。<br>三、合理的前牙形态<br>功能决定形态。<br>四、功能运动中的机械性能与几何形态<br>理想的咬合力的水平分力会造成弯曲，这是对切牙最主要的挑战。<br>牙釉质和牙本质都是脆性材料，它们的抗压强度高于抗拉强度。<br>抗压强度与抗拉强度比率不协调的脆性材料的断裂标准（改良性Von Mises标准，mVM），从牙尖交错位开始，最初的制导不产生显著的应力。运动到切端相对的位置，可以检测到明显的拉力集中在舌侧窝上。<br>需要牢记，最大隆突面上的应力水平低，例如舌隆突和唇面颈缘部分。因此可以总结出，具有较厚牙釉质的凸面比凹面区受到的应力集中量低，而在凹面易产生应力集中。<br>带有明显双面凸起的尖牙（唇舌截面）展现出几乎完美的凸起设计，它造就出理想的机械构造。<br>总结：①舌侧的凹度为切牙提供了锐利的边缘和切咬的能力，但它也是应力集中区。②某些特别区域具有较厚的牙釉质能弥补上述缺点，发挥重新分布应力的作用，例如舌隆突和边缘嵴。舌隆突和边缘嵴顶还起到必要的舌侧终止点的作用，在前牙区维持咬合的垂直距离。<br>五、生理性釉质纹和釉牙本质界<br>当应力传导至性质不同而又简单结合的两层结构上时，常会在界面间产生应力集中。而天然牙长期使用，釉质的裂纹却很少影响釉牙本质复合体结构的完整性，原因在与釉牙本质界的复杂结合，这种结合可以看作是增强的纤维性粘结。<br>六、天然牙的老化而釉质变薄<br>釉质可以抵抗牙合力的磨耗但质脆容易产生裂纹。而牙本质有弹性，柔韧性好，但不易抵抗磨损，如直接暴露于口腔环境中，会有不利的增龄性变化。它们组成的复合结构却赋予了牙齿独一无二的特性，坚硬釉质保护了较软的牙本质，而牙本质阻止裂纹延伸的效应即釉牙本质界处较厚的胶原纤维弥补了釉质内在的脆性。最大的磨耗区具有最厚的釉质层，如前牙的切端。面对逐渐变老而同时在口内保留了更多天然牙的人群，牙列的增龄性变化是现代牙科需要面对的主要挑战。切端过度的磨耗导致前牙突度的丧失，切导作用不足。牙本质暴露，釉质出现裂纹，及外界物质渗透导致的颜色变化加重了这种退化的表现。唇面釉质具有足够及均匀的厚度对前牙功能状态下应力的平衡有至关重要的作用。唇颊面釉质的大量丧失，或存在通向髓腔的龋洞的牙釉质缺损，或大型三类洞对冠的强度有更大的影响。恢复最初釉质的厚度和结构对牙冠的生物力学平衡是必须的。其中修复材料是关键。釉质厚度的恢复结合了美学和生物力学。瓷的粘结修复有望逆转老龄牙齿的非美学外观。<br>七、与机械性能相关的生物学性能<br>已经证实了粘结技术的效能，在重建牙冠硬度的同时能最大限度地保存剩余的牙体组织（冠内增强）。粘结复合树脂修复体能恢复牙体的硬度，这是银汞充填体所不能达到的效果。复合树脂的限制：一个限制是弹性模量，低于牙釉质的弹性模量（大约80GPa）。当一个弹性较大的材料代替了牙釉质外壳时，仅能恢复牙冠刚性的一部分。大部分牙科瓷材料的最大抗拉强度高于牙釉质。根据仿生学原则，类似这种强化瓷的高强度并不需要。另一方面，因为瓷贴面治疗保存了自然的特性，通常牙齿的舌侧和功能面保持完整，不会由于对颌牙的作用出现磨耗的问题。<br>根据仿生学原则得出合理结论：修复的手段应该有助于制作出与下方牙体组织机械性、生物性、光学性更匹配的修复体，而不是最强的修复体。<br><strong>(总结：不应该总是追求修复体的强度，硬度，而要使修复体能与天然牙匹配，尽可能保存天然牙的生物性、机械性、功能性和美观性。牙釉质和牙本质都是脆性材料，耐压不耐拉。釉质和牙本质的机械性质差别很大。釉牙本质界的特殊性质能使这两种材料能很好的结合，发挥作用。最大的磨耗区有最厚的釉质层。)</strong></p>
<p>我发文章的三个地方，欢迎大家在朋友圈等地方分享，欢迎点“好看”。<br>我的个人博客地址：<a href="https://zwdnet.github.io/">https://zwdnet.github.io</a><br>我的个人博客地址：<a href="https://zwdnet.github.io/">https://zwdnet.github.io</a><br>我的CSDN博客地址：<a target="_blank" rel="noopener" href="https://blog.csdn.net/zwdnet">https://blog.csdn.net/zwdnet</a><br>我的微信个人订阅号：赵瑜敏的口腔医学学习园地<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/other/wx.jpg"></p>

      
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